UNC Hospitals Face Medicare Penalties

UNC Hospitals may have to pay millions in Medicare penalties for a high number of patient infections and complications, according to a provision of the new health care law.

In an effort to lower health costs, the Affordable Care Act has authorized Medicare to make assessments of hospital-acquired conditions, and crack down on hospitals that aren’t meeting their standard.

Preliminary scores show 16 N.C. hospitals are currently at risk of penalties, including two of the largest in the Triangle: UNC Hospitals and WakeMed in Raleigh.

Medicare authorities score on a ten-point scale, with the worst of the infections and health complications of hospitals ranking higher. UNC Hospitals was scored at 7.375; WakeMed received a score of 8.025.

All scores above 7 fall below the 25th percentile.

“Medicare is comparing all hospitals across the country, but it isn’t making any adjustments or consideration for how sick the patients are to begin with. So if one hospital takes more sicker patients than another, it’s reasonable to think that there may be, in the aggregate, more infections. But that may not have anything to do with the quality of care that’s provided in the hospital.”

That’s Brian Goldstein, executive vice president and chief operating officer at UNC Hospitals on why its 801-bed facility ranks higher than most in hospital-acquired conditions.

Goldstein says the scores are self-reported and submitted to Medicare by UNC Hospitals, and rankings are calculated solely through assessments of Medicare billing, and monitoring hospitals for infections.

Hospitals were notified of their scores in April, allowing for administration to review their rankings before the final scores and penalties are released in the fall and administered in the 2015 fiscal year.

The scoring system has no minimum passing grade, leaving hospitals that do not receive a performance requirement score less than 7 with definite penalizations, and a 1 percent cut in Medicare reimbursements.

The program does not recognize any patient care documentation or factors outside of their final tally of infections, such as how sick the patients are upon admittance, or the socioeconomic backgrounds of hospital patients.

“Twenty-five percent of hospitals are going to get penalized through this program, no matter how much they improve,” Goldstein said. “The actual scoring is based on how the hospital compares to itself from a baseline period of 2006 or 2007. That’s how Medicare chose to score this so, let’s say, you’re a hospital that wasn’t doing so well in 2006 and 2007, but now you’re doing better. You’re going to get a better score. Now, let’s say you were already doing well (at that time) and you didn’t improve as much and your infection rates might even be lower than the other hospital but you’re still going to get a worse score in this program.”

Goldstein compares this system to a teacher “grading on a curve”, and announcing on the first day of school that 25 percent of students will automatically fail, no matter how well they do throughout the course – just because that is class policy.

The penalties provided by the Affordable Care Act have been a controversial hot topic in the hospital industry, as many of the largest and more research-based hospitals treat the sickest patients, putting them at a higher risk of infections and other common complications.

Goldstein told WCHL the Association of American Medical Colleges recently wrote to the Centers for Medicare and Medicaid Services to alter their scoring system for a more holistic reflection of the quality of a hospital’s care.

With final scores soon to be released, Goldstein says he believes it’s important for the Medicare system to be reformed, but also for hospitals across the nation to keep their focus on the health and safety of their patients.

“We could go a lot deeper and wider in discussing all of the efforts we make everyday to aggressively find and fix problems that could lead to safety issues and quality. That all needs to continue, but all we’re asking for is for these programs that tie back to dollars to be based on a fair assessment of the data that all hospitals provide.”

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